This application proposes to evaluate the first regional roll-out of a unique statewide, multi- stakeholder-based implementation of Patient Centered Medical Home (PCHM) on practice redesign for chronic illness care in Pennsylvania. This is intervention is distinctive with significant multi-payer-based provider incentives facilitated by the PA Governor's Office for Healthcare Reform (GOHCR). This application proposes to study the 25 practices involved in the first of the regions of this statewide initiative, Southeastern PA (SEPA). The SEPA intervention began in May 2008 and includes a 3-year learning collaborative, Improving Performance in Practice (IPIP) practice coaches, and required monthly registry and narrative reports. Significant financial incentives for implementation are paid to providers from the region's major health insurers and are assured by contracts between practices, providers and GOHCR. Varied practice types are included in the collaborative including family medicine, internal medicine, residents, and Federally Qualified Health Center (FQHC) practices varying in size. A multi-method evaluation will include quantitative assessments of clinical outcomes and service utilization and cost, and qualitative approaches will be used to identify unanticipated constructs of interest and obtain perceptions of quality, implementation processes and procedures, and variables that affect PCMH implementation and performance on a daily basis. The goal is understand the impact of this intervention and identify barriers and facilitators for the initiative to help disseminate the process to improve primary care in other settings. PUBLIC HEALTH RELEVANCE: The purpose of this application is to evaluate a multi-stakeholder primary care redesign initiative facilitated by the Pennsylvania Chronic Care Commission focused on improved care for diabetes. The initiative is based on the Patient Centered Medical Home model to coordinate all aspects of patient care and improve patient-physician interaction and satisfaction. The goal is understand the impact of this intervention and identify barriers and facilitators for the initiative to help disseminate the process to improve primary care in other settings.